~ June Girvin

So what’s changed?

In a recent Twitter conversation I was asked if I would blog about what has changed in nursing over the years that I have been a nurse. Blimey! Where to start!? Nearly 40 years is a long time. After a bit of thinking (and a lot of distracting nostalgia!) I’ve picked a couple of things that I think have really changed – see if you agree.

I qualified in 1976 and left the NHS in 2001. I’m still on the professional register, although now I work in the Health and Life Sciences Faculty of a university. So I’ve been a registered nurse, either in practice, or involved with nursing, for some 38 years. Here I am, in the pic below left, on the day that I received my certificate. I was just 21.

Most of my cohort – a group of about 120 – were pretty much the same age – straight from school. There were two or three girls (we were mostly female, there were two chaps) who had already completed degrees in other subjects or who had come to nursing after having worked at something else for a while, but all of these were well under thirty. There was one ‘mature’ student, in her late forties I would think, and she was a nun. None of us were married at the start of our training – unless you count the nun. Four of us were married by the end – if you count the nun. Many of my cohort became ‘engaged’ (as you did in those days) by their third year and planned to work for 6 months after qualifying before they married. Very few of us (including me) talked about nursing as a life long career. As students, we all lived together in the Nurses Home.

So here are the first differences – in 2012 the average age of a student nurse was 29 and over 40% of them had children or other dependents. That’s quite a shift – in age and in circumstances. Many more men choose nursing as a career, about 10% of cohorts on average, if the numbers entering the register are anything to go by – in my cohort it was barely 2%. Less than 50% of student nurses now are living in university halls – the rest live at home, juggling study, kids, family etc. etc. Very, very different. That average age of 29 masks quite a range of ages. There are those who come to nursing in early middle age, some later, they do their degree in a cohort of mixed ages and everyone brings a perspective that will help them in their careers. It seems odd to me that the media and much of the general public still perceive student nurses to be young, single and female. It’s a view that’s thirty years out of date.

My clinical experience was all in the acute sector. In the early years of my career, if you were a Registered Nurse working clinically in hospital you were a Staff Nurse or a Sister/Charge Nurse. You were a specialist by virtue of the ward you worked on, and if you were Sister/Charge Nurse on a ward/theatre/Casualty then you were considered an expert in that field. A few specialist post-registration courses began to appear, but they were few and far between. Mostly a nurse’s work was directed by the Sister/Charge Nurse, based on the treatment pattern expected by the relevant Consultant. It was Staff Nurse, maybe Senior Staff Nurse and Sister – and the way through these layers was by years of experience.

And the differences? Specialising today requires a commitment to advanced education, to demonstrating specialist knowledge and to being on top of the latest developments and latest evidence in a chosen field. The opportunities to contribute to care are significantly increased alongside Staff Nurse and Sister/Charge Nurse – Clinical Nurse Specialist (in any number of fields), Advanced Practitioner, Clinical Research Nurse, Practice Development, Lecturer Practitioner, Nurse Researcher etc. etc. In fact, if there’s a function, then somewhere there’s probably a Specialist Nurse role that’s got it covered. And the way into these posts is through education – rigorous, challenging, demonstrating the deeper expertise and the critical thinking that enables greater autonomy, stronger contribution to patient outcomes, confident competence and an acceptance of accountability. Relying on direction is long gone. So, it’s odd again, isn’t it, that the received wisdom seems to be that all nurses do pretty much the same job, and those jobs need nothing more than warm hands and a kind heart and an ability to follow instructions. Views that, again, are thirty years out of date. We really need to work harder to change this.

I’m not going to mention the changes in education preparation for the register, it’s too obvious, and there’s not enough room! And if there’s one thing that does seem to have made it into the received wisdom consciousness it’s the fact that nurses are educated differently from 30 years ago. I did spend a while thinking about the clinical changes, but there’s so many, I think that’s for another day – oscilloscopes not monitors, glass suction drains, Roberts motors, milking chest tubes anyone? 🙂